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Sie in the sense of she can easily be recognized by the form of the verb. Sie in the sense of formal you and of 3rd person plural can be mixed up in spoken language. If there is a chance of mixing them up, you have to clarify, mostly by gesture and looks, because if you talk to someone you look at him/her, while if you talk about someone else you often look in the direction of whomever you're talking about. I'm sure there are mix ups, but I think they are surprisingly rare. One example: http://www.spiegel.de/kultur/zwiebelfisch/zwiebelfisch-sie-oder-sie-du-musst-dich-entscheiden-a-316185.html (Look at the text under the picture)
I think so, if it comes to action verbs, I can't distinguish between "sie" (they/plural) and "Sie" (formal form of "you"/singular). "You are drinking water" and "They are drinking water" can have the same translation in German : "Sie trinken Wasser".
But in simple verb, we can distinguish it by looking at the context. It's like how you distinguish between the single "you" and the plural "you" in English. For example : "Sie sind ein Mann". I can say the subject of this sentence is singular, because it means "a man". So "Sie" in there means "You" (formal form); You are a man. While in "Sie sind Männer", the subject is plural, because "Männer" is the plural form of Mann. So "Sie" in there means "they"; They are men. Hope it helps. :)